Compressing morbidity improves late-life quality by Andrew Binns In one of the most famous lines in American literature – uttered by Nick Romano in Willard Motley’s long-forgotten novel Knock on any Door – the advice is to “Live fast, die young, and leave a goodlooking corpse.” A number of rock singers and others have heeded this advice, although the state of their corpses has often fallen short of the mark. In the opposite corner stands Rheumatologist and Stanford University Professor Dr James Fries who more than 40 years ago coined the term ‘compression of morbidity’, meaning to minimise the duration of chronic disease suffering before death, the aim being to improve the quality of our older years. For budget watchers such as politicians this wise advice also relates strongly to the subject of health costs. Although compression of morbidity has now become a key goal of healthy ageing and longevity it may be easier to express than to achieve, unless appropriate strategies are put into place. The evidence emerging from research in recent decades shows that while pharmaceuticals are an important factor they are not the whole answer, with the issue of lifestyle being increasingly recognised as a crucial factor. Enter, the evidence based discipline called Lifestyle Medicine, which now has an established following throughout the world. Locally we have the Australasian Society of Lifestyle Medicine. Two major health issues are related closely to healthy ageing, sarcopenia, which is the toll of time on muscle strength, and the prevention or delaying of early dementia. The former has both metabolic and musculoskeletal implications that can impact on morbidity, mortality rates and quality of life. Regarding dementia, there is a huge amount of research going on to find pharmaceutical solutions, but in the meantime much can be achieved with lifestyle changes. There is a strong overlap between lifestyle changes needed for prevention of both sarcopenia and cognitive impairment with ageing. For prevention of dementia the Lancet 18 | NorDocs
Commission on Dementia Prevention in 2017 cited nine causes for dementia • Less education • Hypertension • Hearing impairment • Smoking • Obesity • Depression • Physical inactivity • Diabetes • Infrequent social contact A further three were added in 2020 • Excess alcohol • Head injury • Air pollution Modifying these risk factors will prevent or delay up to 40% of dementia cases. Preventing sarcopenia with lifestyle measures will overlap significantly with these measures, particularly by addressing blood pressure and weight control, diabetes prevention, physical inactivity, depression, social contact and alcohol overuse. Diet and exercise are crucial addressing these health issues.
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As regards diet the evidence favours the Mediterranean Diet, but it has been added to by combining with the Dietary Approaches to Stop Hypertension (DASH) diet to form the MIND diet. As regards exercise for prevention of dementia and sarcopenia a combination of aerobic and resistance training is needed. As regards sarcopenia and increasing physical activity the benefits are significant for building up muscle whilst increasing metabolism. To quote from Nutrients 2020 June 12 (6) 1755…
‘Although adherence to the Mediterranean Diet may be beneficial to prevent frailty and sarcopenia in older adults, there has been great variability in the populations studied. The ethnic differences in populations and how they might modify the components of the Mediterranean Diet could have an impact on the results. Furthermore, more studies need to evaluate the impact of the Mediterranean Diet on incident sarcopenia, while there is mounting evidence to support the hypothesis that the Mediterranean Diet preserves muscle mass and some physical function in aging populations.’ When it comes to exercise to prevent sarcopenia referral to an Exercise Physiologist is helpful. To begin managing the situation they will start by doing some measurements to assess the degree of muscle loss. The main tests are grip strength, 5x sit-to-stand test and gait speed. More sophisticated testing for measuring lean muscle mass uses scanning technology which is certainly used for research. But simpler assessment is usually all that is needed for most cases. They will then devise appropriate aerobic and resistance training exercises personalised to the patient’s needs and abilities. In summary the key to preventing dementia, sarcopenia and to the overall compression of morbidity is to address lifestyle issues, and the earlier in life one starts the better. However, it is never too late. See the Lancet report at - Dementia prevention, intervention, and care: 2020 report of the Lancet Commission
